Fillable FOSTER/ADOPTIVE PARENT APPLICATION (County Of Pitt)

Fill Online, Printable, Fillable, Blank FOSTER/ADOPTIVE PARENT APPLICATION (County Of Pitt) Form

Use Fill to complete blank online COUNTY OF PITT (NC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FOSTER/ADOPTIVE PARENT APPLICATION (County Of Pitt)

On average this form takes 41 minutes to complete

The FOSTER/ADOPTIVE PARENT APPLICATION (County Of Pitt) form is 6 pages long and contains:

  • 0 signatures
  • 44 check-boxes
  • 145 other fields

Country of origin: US
File type: PDF

U.S.A. forms for County Of Pitt

BROWSE COUNTY OF PITT (NC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Pitt County Department of Social Services
1717 W. 5
th
Street
Greenville, N.C. 27834-1696 ( 252) 902-1110
FOSTER/ADOPTIVE PARENT APPLICATION
Your Full Name:
(First) (Middle) (Maiden) (Last)
Social Security #:
Date of Birth:
Address Where You Live:
Mailing Address if different from above:
Phone Numbers: Home: Work: Cell:
E-mail address:
Please indicate One:
Single Married
Divorced Widow/Widower
Date:
Spouse/Partner’s Full Name:
(First) (Middle) (Maiden) (Last)
Social Security #:
Date of Birth:
Did you graduate from high school?:
Yes No
Did your spouse/partner graduate from high school?:
Yes No
If you did not graduate: (see next line)
What was the last grade you completed?
Your Spouse/partner?
Did you or your spouse/partner receive additional education after high school?
Yes No
If yes please list type of certificate or degree earned in the space below:
Do you have a valid driver’s license?
Yes No
What is the Driver’s State and License Number?
Does your spouse/partner have a valid driver’s license?
Yes No
Spouse/partner’s Driver’s License State and Number, if applicable:
Do you currently live in a house, apartment or a mobile home?
Are you buying your home or do you rent?
How many bedrooms are in your home?
Do you currently have a job?
Yes No
If yes, where are you employed?
How long have you been employed there?
What are your work hours?
How often do you get paid?
What is your monthly salary?
What is your work phone number?
If unemployed, how long has it been since you last worked?
Where did you last work and for how long?
Does your spouse/partner currently have a job?
Yes No
If yes, where employed?
How long employed?
Work Hours?
How often paid?
What is the monthly salary?
What is the work phone number?
If unemployed, how long has it been since you last worked?
Where did you last work and for how long?
Please tell us about the last 3 places you have worked:
Name of Company How long did you work there? Why did the job end?
Please tell us about the last 3 places your spouse/partner has worked
Name of Company How long did you work there? Why did the job end?
What are your Monthly Household Expenses?
Rent/Mortgage:
Utilities- Gas/Electric:
Water:
Car Payment(s):
Car Gas:
Car Insurance:
Life Insurance:
Health Insurance:
Telephone/Pager/Mobile:
Credit Cards: Payment: Payoff:
Miscellaneous (Dry Cleaning, Hairdressing, Cleaning):
School Loans:
Cable TV/Satellite:
Food (Groceries/Eating Out):
Loan Payments:
Medical Payments:
Other:
Is there any other source of income for the family?
Yes No
If yes, what type of income?
What is the monthly amount?
List who currently resides in your home along with the relationship to you:
Name/Relationship Date of Birth Social Security #
List any children you or your spouse/partner have that do not reside in your home:
Name DOB SS#
Do you have a support system of friends and/or family to assist you with caring for your own children, or for any
children who might be placed in your home?
Yes No
Please explain:
Would you be willing to share your telephone number with other foster and/or adoptive parents for the purpose of
providing support to each other?
Yes No
How long have you lived at the current address?
Please list the last three addresses where you have resided and the length of time you resided there:
1.
2.
3.
Do you have a swimming pool?
Yes No
If yes, type of pool:
Are there any other hazards near your home, such as bodies of water, a busy road, or a trampoline?
Yes No
If yes, please explain:
Have you or your spouse/partner ever been convicted or charged with anything other than a MINOR traffic
violation?
Yes No If so, please explain below:
Do you or your spouse/partner have any health problems?
Yes No
If yes, please explain in space provided below:
Do either you or your spouse/partner take any medications?
Yes No
If yes, please list the medications and who takes them:
Name of Medicine
Name of Person
What it is For
Have you or your spouse/partner ever been hospitalized for any reason? If yes, please explain the situation:
Have you or your spouse/partner ever received mental health services?
Yes No
If yes, When
Under what circumstances? (explain below)
Have you or anyone in your family ever been investigated by ANY Department of Social Services for
Child Abuse/Neglect
Yes No or Adult Abuse/Neglect? Yes No
If yes, Please explain the situation in detail giving names, dates and dates of birth as well as the relationship:
If you or your spouse/partner did have relatives taken into custody, what kind of involvement did you have with
the situation?
Have you or anyone in your family had any relatives that were taken into the custody of the Pitt County
Department of Social Services?
Yes No If yes, please explain the situation in detail giving names,
dates, dates of birth as well as the relationship:
Have you or your spouse/partner ever made an application with this agency or any other agency for adoption or
foster care?
Yes No If so, please give the name of the agency and the results of your contact:
Please state briefly your reasons for wanting to become foster or adoptive parents:
Signature Date
Signature Date
Click HERE to PRINT
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FOSTERADOPTIVE PARENT APPLICATION (County Of Pitt)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document